Provider Demographics
NPI:1235902107
Name:QUINTAS, BRYAN MATTHEW
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:MATTHEW
Last Name:QUINTAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968 W ADAMS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-3515
Mailing Address - Country:US
Mailing Address - Phone:323-731-3534
Mailing Address - Fax:
Practice Address - Street 1:1968 W ADAMS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-3515
Practice Address - Country:US
Practice Address - Phone:323-731-3534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator